Kurtovic, J.; Riordan, S.M.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA10
Academic Journal
Background: Limited data suggest a high prevalence of lactose maiabsorption (LM) in the elderly. The mechanism is uncertain. A significant increase in enterocyte apoptosis raises the possibility that a subtle reduction in mucosal absorptive area, undetectable by standard structural analyses may be responsible especially if compensatory enterocyte prolireration is inadequate. Assessment of intestinal absorption of mannitol, taken up transcellularly and hence an index of absorptive area, and intestinal permeability, reflected by urinary lactulose/ mannitol ratios, may resolve this issue. Methods: We studied 20 asymptomatic elderly subjects (median age 76, range 65-94 years) and 20 controls (median age 29, range 21-35 years) with no history of gastrointestinal disease or use of drugs that disturb gut permeability. All were hydrogen producers following ingestion of lactulose. A 50 g lactose breath hydrogen test was performed after dietary preparation and an 8 hour fast. Breath hydrogen was measured by gas chromatography. Lactulose/mannitol ratios were measured by gas-liquid chromatography in urine collected over 6 hours after ingestion of 10 g lactulose and 5 g mannitoh Urinary creatinine levels were measured so that differences in renal function did not confound interpretation of urinary mannitol levels. Results: LM, defined by a rise n breath hydrogen > 20 ppm above baseline, was present in 10/20 (50%) elderly subjects and 0/20 controis. Urinary mannitol/creatinine ratios did not differ significantly in elderly and control subjects (median 111.1, range 17.6-149 v median 92.8, range 45.9-140.8; p = 0.62) or in elderly subjects with and without LM (median 111.1, range 35.6-149 v median 106.7, range 17.6-138; p = 1.0). Urinary lactulose/mannitol ratios were significantly increased in the elderly (medan 0.018, range 0.007-0.063) compared to controls (median 0.011, range 0.0070.025; p = 0.003), but did not differ significantly in elderly subjects with and without LM...


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